Cytomegalovirus (CMV) infection is caused by a common virus that belongs to the herpesvirus family. It is widespread and can infect people of all ages. While most CMV infections are asymptomatic, meaning they don't cause noticeable symptoms, the virus can lead to serious health issues in newborns and individuals with weakened immune systems. CMV is primarily spread through bodily fluids, including saliva, blood, urine, and breast milk.
Presentation
CMV infection often goes unnoticed in healthy individuals because it typically doesn't cause symptoms. However, when symptoms do occur, they can resemble those of mononucleosis, including fever, sore throat, fatigue, and swollen glands. In newborns, CMV can cause hearing loss, developmental delays, and other serious health problems. In immunocompromised individuals, such as organ transplant recipients or those with HIV/AIDS, CMV can lead to more severe complications, including pneumonia, retinitis (inflammation of the retina), and gastrointestinal issues.
Workup
Diagnosing CMV infection involves a combination of clinical evaluation and laboratory tests. Blood tests can detect CMV antibodies, indicating a current or past infection. Polymerase chain reaction (PCR) tests can identify the presence of CMV DNA in blood or other body fluids, confirming an active infection. In newborns, urine or saliva tests are often used to diagnose congenital CMV infection. Imaging studies, such as CT scans or MRIs, may be necessary to assess organ involvement in severe cases.
Treatment
Treatment for CMV infection depends on the severity of the disease and the patient's immune status. In healthy individuals, treatment is usually not required as the infection resolves on its own. For those with weakened immune systems or severe symptoms, antiviral medications such as ganciclovir, valganciclovir, or foscarnet may be prescribed to control the infection. In cases of congenital CMV, antiviral treatment may help reduce the risk of long-term complications.
Prognosis
The prognosis for CMV infection varies based on the individual's health and immune status. In healthy individuals, the infection is usually mild and self-limiting. However, in newborns and immunocompromised patients, CMV can lead to significant health issues. Early diagnosis and treatment can improve outcomes, particularly in high-risk groups. Long-term monitoring may be necessary for those with congenital CMV or severe complications.
Etiology
CMV is caused by the cytomegalovirus, a member of the herpesvirus family. Once a person is infected, the virus remains in the body for life, often in a dormant state. Reactivation can occur, especially in individuals with weakened immune systems. CMV is transmitted through direct contact with infected bodily fluids, including saliva, blood, urine, semen, and breast milk. It can also be transmitted from mother to child during pregnancy, childbirth, or breastfeeding.
Epidemiology
CMV is a common virus, with a significant portion of the population exposed to it by adulthood. The prevalence of CMV infection varies by region and population, with higher rates in developing countries and among lower socioeconomic groups. Congenital CMV infection occurs in about 0.5% to 1% of all live births, making it a leading cause of birth defects and developmental disabilities. Immunocompromised individuals are at higher risk for severe CMV-related complications.
Pathophysiology
CMV infects a wide range of cell types, including epithelial cells, endothelial cells, fibroblasts, and leukocytes. The virus can evade the immune system by downregulating the expression of major histocompatibility complex (MHC) molecules, which are crucial for immune recognition. In immunocompetent individuals, the immune system typically controls the infection, keeping the virus in a latent state. In immunocompromised individuals, the virus can reactivate, leading to widespread organ involvement and severe disease.
Prevention
Preventing CMV infection involves practicing good hygiene, such as regular handwashing, especially after contact with bodily fluids. Pregnant women should take extra precautions to avoid exposure to CMV, particularly if they work in settings with young children. Safe sex practices can reduce the risk of transmission through sexual contact. For high-risk individuals, such as organ transplant recipients, prophylactic antiviral medications may be recommended to prevent CMV reactivation.
Summary
Cytomegalovirus infection is a common viral infection that often goes unnoticed in healthy individuals but can cause serious health issues in newborns and those with weakened immune systems. Diagnosis involves clinical evaluation and laboratory tests, while treatment depends on the severity of the infection and the patient's immune status. Preventive measures, including good hygiene and safe sex practices, can help reduce the risk of CMV transmission.
Patient Information
Cytomegalovirus (CMV) is a common virus that many people carry without knowing it. Most healthy individuals don't experience symptoms, but the virus can cause problems for newborns and people with weakened immune systems. CMV spreads through bodily fluids, so practicing good hygiene and safe sex can help prevent infection. If you're pregnant or have a weakened immune system, talk to your doctor about ways to protect yourself from CMV.